| NPI | 1407397144 |
|---|---|
| Former Legal Business Name | GLEN ROSE FAMILY DENTAL |
| Entity Type | Organization |
| Authorized Contact | CLAYTON K COOK Owner/Dentist 817-294-1090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 29154) |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2021-09-28 |